Sridhar [Sri] B. Seshadri is SHC’s vice president, planning and process excellence. But what does that mean?

Seshadri and his team — currently an eclectic mix of six professionals —have coached, not led, such high-profile “90-day Rapid Results Projects” as major changes in the operating room, the new Cancer Center, ICD-9 [diagnoses] coding, transcription processes, etc.

The process excellence veep received his BSEE in 1982 at Bangalore University in the city now known as the heart of India’s Silicon Valley. He also holds advanced engineering degrees from Drexel University in Philadelphia and an MBA in business from Wharton Business School. He began his professional career in the health care field as an engineer and planner in 1985 at the University of Pennsylvania’s Radiology Department. Nine years later — just a year after receiving his MBA — Seshadri served as a manager in increasingly broader jobs for the Health Imaging Division of Eastman Kodak. Before coming to Stanford in 2003, he was vice president and general manager of Healthcare Solutions for General Electric’s Medical Systems (GEMS); this business focused on mentoring GE’s clients in Six Sigma principles and projects.

And as he will tell you, he is still an engineer at heart, despite increasingly responsible management and organizational positions.

What can he do to facilitate benefits for physicians and SHC as a whole? We asked him.

Q: Okay, so please, can you tell us what your job is here at Stanford?

SESHADRI: I work in three areas. First we facilitate operational projects intended to benefit our customers — which include patients, staff physicians, referring physicians, and employees. Second, and less concretely, we try to build an “operating rhythm” for the organization. When I was hired, [CEO] Martha Marsh said it would be nice to learn from some of corporate America’s operating principles and adapt them to SHC. I’d worked for GE, which is known for its operational rigor — so we leveraged some of their best practices to our operations. The third aspect of my job is to work on the strategic plan with our colleagues at the medical school. What should we look like, who should we be in five or 10 years?

Q: I think physicians might be interested in what projects you have done to benefit them. Any examples?

SESHADRI: Sure, but I want to preface my remarks with some reassurances about what we don’t do —that’s tell doctors how to practice medicine. Our focus is to improve those operational processes that “envelop the clinical event”. If we were to do something as brash as tell our specialists, “Improve your service levels,” they would correctly respond, “Improve my service levels first. Get me my transcriptions on time, get my supplies and instruments into the OR — give me the tools I need to do my job.”

Q: Why shuld doctors care about improved processes? After all, "This is Stanford." Won't people come here for superior care even if doctors have more important things to do than iron out inconveniences?

SESHADRI: I get asked that frequently. What I say is that maybe such an approach may have been valid 10 years ago, but all of the survival indicators point to the need for us to optimize efficiencies on all levels. A fairly recent New England Journal of Medicine article essentially concluded that in pure economic terms, academic medical centers should have gone out of business years ago. But this is not the case — there is a strong synergy between the academic and the operational/clinical side that somehow allows the academic model to work well. I believe in that model, but I don’t think it will continue to be successful unless we optimize our operations.

Q: Please tell us about some of the improved processes.

SESHADRI: Some of the work we did to help get the Cancer Center up and running may offer insights into how process excellence works. I’m an engineer, and the first thing I thought we needed to do was to break down and look at the process and sub-processes. I realized we had a brand new building with 13 separate, disparate programs staffed and led by people who had rarely if ever worked together before. So we took everyone through a process training program with the mantra, “If you want optimal flow you have to have consistent ways of seeing that a room is available, that you’re ready for the next patient, that tests are completed,” and so forth. Related to that was a technique called future state brainstorming. We told physicians and staff, “Forget what you’re doing now, what exists now,” and we spent an afternoon as a group envisioning what the Cancer Center could be. At one point the discussion turned to the reality that patients in the Infusion Treatment Area could face four or five hour waits as physicians, nurses, pharmacists and support staff grappled with trying to contact each other separately and serially to find out the status of patients. At that point, someone recalled a cult television show and suggested, “Wouldn’t it be great if we had a Star Trek communicator we could tap to talk to the entire care team.” At first there was laughter, but we took that germ of an idea forward and actually found a company in Cupertino [Vocera Communications] that makes a small badge that delivers hands-free voice mail, telephone, and text messaging all rolled into one. Best of all, it provides conference call capability and automatically dials a voice activated phone tree programmed, for example, to “get John and Mary,” or “next available pharmacist”. We started with 25 badges, and now we’re now up to 85 or 90. We’re hoping to expand this program. Once the hospital itself is wireless, we could use this technology elsewhere, for example in the operating room.

Q: Does your staff lead the projects?

SESHADRI: No, and that’s an important point. Our people are coaches. Every team has a leader, often a physician, who is part of the process we are working on. We develop at least two or three points of goal, an intersection, to show how the projected change can benefit everyone involved — patients, the hospital, medical school, and physicians. Without such buy-in the project won’t go forward.

Q: You call your people coaches. Who are they?

SESHADRI: I’ve built a team slowly in the past three years. We have a diverse group. For example, Buffie Stark has had significant experience in managing surgery clinics. Kate Surman, an MBA from Stanford, comes from DHL, the package expediter, a company which is incredibly good about workflow; Elena Pernas-Giz is another Stanford MBA who is a physical therapist by training; Leitha Sangermano is a nurse manager who successfully led a large inpatient unit before joining our team; Freida Acu used to run the Surgery Admissions Unit and is “on-loan” to our group for a couple of years. My goal is for people in my area to work in process for a few years and then go out on the line to seed the organization with people who understand process, know how to drive change and how to break down barriers. That’s what my team is learning right now.

Q: Has the medical staff been receptive of your ideas?

SESHADRI: Well certainly not always immediately! For example, we have worked on a project to improve timely chart completion in the operating rooms. In 2004, only 34 percent of charts were complete and available in the OR at the time a surgery was scheduled to start. Incomplete charts led to “seek and search” mission on the day of surgery — causing significant inconvenience to patients, physicians, and staff. When we launched this project, there was significant push back from the surgeons because there were no clear direct benefits for surgeons. However, with the leadership of the OR medical director, our CEO, and our dean we have made much progress in this area. We simplified and standardized a number of the processes, improved the equipment, and created a “chart completion” room. We created “transparency” by publishing chart-completion percentages from all services. We also built a set of incentives to improve performance. We gave out dinner certificates to surgeons who completed 100 percent of their charts for three months running. An interesting thing happened. Several surgeons were pinning the certificates to their office walls instead of cashing them in for free meals — peer recognition seemed more valuable than the free dinner. We also informed surgeons that they would lose their 7:30 a.m. start-time privileges if they consistently failed to complete their charts on time. But competition appeared to be the dealmaker: we published completion statistics — surgeons are very competitive folks and no one wanted to be in the bottom quartile. When we started the project we had a rather dismal 34 percent on-time chart completion; we are now at about 86 percent. In a similar way, we have improved on-time starts from a baseline of 19 percent to about 82 percent over the last two years.

Q: So in this project you found aligned goals to drive success?

SESHADRI: Absolutely. Surgeons were happier by not having to wait, staff were delighted not to have to search for charts, and patient were moving into the OR on-time. It’s all about aligning goals.

Q: Do you listen to patients in developing projects?

SESHADRI: Definitely. We use a paradigm called “voice of the patient” as part of our analysis. A year or so ago, we found that Cancer Center patients were being given thick binders with every conceivable piece of information. That seemed reasonable to most people, but then we had comments from one patient who said, in effect, “It freaks me out that when you come in for cancer treatment, they dump a huge white binder on you.” Now we give out binders and add pages of information “just in time” as needed. Patients are happier and they are able to absorb the practical information they need.

Q: Have all of your projects succeeded?

SESHADRI: We can wish. Actually, we are achieving 65 to 70 percent measurable successes. The rest are learning experiences.

Q: What have you learned from projects which didn’t work?

SESHADRI: Early on we found that once you start projects at Stanford it is very hard to stop them even if it is crystal clear that the project has a zero percent chance of success. We stubbornly pressed forward on one patient flow project even after the physician leader had left Stanford. Even worse, the project had no clear benefit to the organization as a whole, and it spilled over into an operational area where we didn’t have a team sponsor. I think we learned to avoid being stubborn.

Q: Can you discuss the strategic plan that underlies what you’re doing?

SESHADRI: The hospital and the medical school — after extensive research and deliberations — have determined we will be known for high end complex care. So we have built our plans around growing tertiary and quaternary care while maintaining a strong secondary care base. We are concentrating on five strategic service lines, but we also have a pretty wide mix of other excellent services. We will continue to nurture secondary care, because it supports the research and teaching mission, offers patient flow into the tertiary/quaternary pipeline, and supports the economics of the enterprise.

Q: Any final philosophical thoughts?

SESHADRI: Sure. Pick a few things you’re going to change, resource them correctly and then drive the dickens out of them. Success is all about execution — clear goals, sufficient resources, good communications, and setting the right expectations.

See sidebar "Voice Activated Device"